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Singapore Delegation Registration Form for Xponential 2016

Fields marked with * are required.
Registration Form to attend HiMSSAsiaPac17

Contact Information

Prefix:*  
    If other, please specify:  
First Name:*  
Last Name:*  
Email:*  
    Receive a Copy
Confirm Email:*  
Position/Title:*  
Company Name:*  
Address:*  
Postal Code:*  
Country:*  
Phone:*      Ext.
Cell Phone:*  
Website  
Fax:  
Brief Company Description:  
I am Interested to attend HiMSS's Presentation:  
Which Country Are you from?   Indonesia
Malaysia
Myanmar
Philippines
Singapore
Thailand
Vietnam


Remarks

 

If you would like to register additional attendees, please include their names and title in the Remarks column.